| NPI | 1144662636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-00740) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 293105) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2025-10-02 |